Sec. 2. Findings
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The Congress finds the following: The writing, passage, and implementation of the Affordable Care Act has utterly lacked transparency. Presidential candidate Barack Obama repeatedly promised that if elected President, he would hold open, public negotiations on health care reform among public and private stakeholders, including at a Democratic Presidential debate on January 31, 2008, when he said, That’s what I will do in bringing all parties together, not negotiating behind closed doors, but bringing all parties together, and broadcasting those negotiations on C–SPAN so that the American people can see what the choices are, because part of what we have to do is enlist the American people in this process. .
Then-Senator Obama repeated this promise multiple times, including at an Ohio town hall on March 1, 2008, when he said, But here’s the thing: we’re gonna do all these negotiations on C–SPAN. So the American people will be able to watch these negotiations. . Then-Senator Obama also repeated this promise at a Virginia town hall on August 21, 2008, when he said, I’m going to have all the negotiations around a big table. We’ll have doctors and nurses and hospital administrators. Insurance companies, drug companies—they’ll get a seat at the table … But what we will do is, we’ll have the negotiations televised on C–SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies.
And so, that approach, I think is what is going to allow people to stay involved in this process. . In a September 26, 2011, interview, Brian Lamb, the CEO of C–SPAN confirmed the negotiations of the health reform law had not been broadcast publicly, noting, The President said that they were all going to be on C–SPAN. He never asked us. . President Obama, in leading the national health reform debate, broke his promise, admitting in a January 25, 2010, interview with ABC News that locking the public out of key health reform discussions was a mistake and explaining, We had to make so many decisions quickly in a very difficult set of circumstances that after awhile, we started worrying more about getting the policy right than getting the process right.
But I had campaigned on process—part of what I had campaigned on was changing how Washington works, opening up, transparency and I think it is—I think the health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters that we just don’t know what’s going on. And it’s an ugly process and it looks like there are a bunch of backroom deals. . On March 9, 2010, then-Speaker of the House Nancy Pelosi said of what would become the Affordable Care Act, We have to pass the bill so that you can find out what is in it. .
Dr. Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology, was awarded a contract by the Department of Health and Human Services to provide technical assistance in evaluating options for national healthcare reform due to his proprietary statistically sophisticated micro-simulation model which could assess the impact of changes in Federal health care policies. Dr. Gruber described himself as a health reform architect who contributed to the crafting of the Affordable Care Act in a 2012 opinion editorial, noting, Several of the architects of Massachusetts reform, including myself, worked closely with the Administration and Congress to translate the lessons from Massachusetts onto the national stage. .
Dr. Gruber’s MIT biography has described him as a key architect of the Massachusetts health reform effort and a 2009 and 2010 technical consultant who worked with both the Administration and Congress to help craft the Patient Protection and Affordable Care Act. . An October 11, 2011, report by NBC News described White House visitor logs that show Dr. Gruber had at least five meetings at the White House in 2009 in the lead up to the passage of the Affordable Care Act, including a meeting in the Oval Office with President Obama to evaluate options for national health reform.
In a video posted April 12, 2012, by the Obama presidential campaign to YouTube, Dr. Gruber states that he went down to Washington to help President Obama develop his national version of that law. . A March 28, 2012, article in the New York Times reports that After Mr. Gruber helped the administration put together the basic principles of the proposal, the White House lent him to Capitol Hill to help congressional staff members draft the specifics of the legislation. . In a January 18, 2012, lecture on the structure of the Affordable Care Act, Dr.
Gruber refers to the law’s small business tax credits as a portion of the bill that he actually wrote. . Dr. Gruber’s initial contract with the Department of Health and Human Services
(HHS)was for $297,000, and later a Federal grant of $95,000 brought his total Federal compensation for work on the Affordable Care Act to at least $392,000. In 2009, the White House annual report to Congress on Presidential staff salaries lists that twenty-two White House staffers made the highest Presidential staff salary rate of $172,200, including the White House Chief of Staff, senior advisers, White House Counsel, and National Security Adviser. In 2010, the White House annual report to Congress on Presidential staff salaries lists that twenty-three White House staffers made the highest Presidential staff salary rate of $172,200, again including the President’s top management, policy, communications, and security advisers. In 2009 and 2010, each of President Obama’s most senior White House staff received less compensation than Dr. Gruber. In a November 5, 2012, speech at the University of Rhode Island, Dr. Gruber described the mechanism of the Affordable Care Act, stating, It’s a very clever, you know, basic exploitation of the lack of economic understanding of the American voter. . At an October 17, 2013, panel at the University of Pennsylvania, Dr. Gruber described the Affordable Care Act, stating, This bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If CBO scored the mandate as taxes, the bill dies. Okay, so it’s written to do that. . In the same speech, Dr. Gruber stated that, if you had a law which said that healthy people are going to pay in you made explicit healthy people pay in and sick people get money, it would not have passed. . Dr. Gruber went on to claim, Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass. . Since the passage of the Affordable Care Act, President Obama called for a new, more transparent approach to the health reform law moving forward, saying in a January 25, 2010, ABC News interview, The process didn’t run the way I ideally would like it to and that we have to move forward in a way that recaptures that sense of opening things up more. . The Obama Administration’s implementation of the Affordable Care Act has been marked by Executive overreach. On at least 28 occasions, President Obama and his administration have unilaterally delayed, extended, or changed provisions of the Affordable Care Act, including in contravention of the law and the Constitution of the United States. Section 1513 of the Patient Protection and Affordable Care Act ( 26 U.S.C. 4980h note) requires applicable large employers with more than 50 full-time employees to provide qualifying health insurance to their employees or pay a fine, and the effective date under such section specified the amendments made by such section applied to months beginning after December 31, 2013. Contrary to the plain meaning of the statutory requirement, and acting without authority provided by law, the Internal Revenue Service published in the Federal Register Notice 2013–45 to change the effective date of the employer mandate requirement, stating, Section 1513(d) of the Affordable Care Act provides that section 4980H applies to months after December 31, 2013; however Notice 2013–45, issued on July 9, 2013, provides as transition relief that no assessable payments under section 4980H will apply for 2014. . On July 12, 2013, the Director for the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services denied the request for exemption from certain Affordable Care Act requirements made by representatives of the United States territories, writing to the Secretary of Commerce for the Commonwealth of the Northern Mariana Islands, However meritorious your request might be, [the Department of Health and Human Services] is not authorized to choose which provisions [of the Affordable Care Act] … might apply to the territories. . A year later, on July 16, 2014, the Administrator of the Centers for Medicare & Medicaid Services notified representatives of the United States territories that they would in fact receive an exemption from requirements under the Affordable Care Act, despite the previous explanation from CMS that CMS does not have the legal authority to provide such an exemption. As the CMS Administrator now rationalized, Currently, the Department uses the existing Public Health Service Act (PHS Act) definition of . State for new PHS Act requirements and funding opportunities included in title I of the Affordable Care Act. Under this definition, the new market reforms in the PHS Act apply to the territories. We have been informed by representatives of the territories that this interpretation is undermining the stability of the territories’ health insurance markets. After a careful review of this situation and the relevant statutory language, HHS has determined that the new provisions of the PHS Act enacted in title I are appropriately governed by the definition of State set forth in that title, and therefore that these new provisions do not apply to the territories. The Obama Administration has claimed that the Affordable Care Act will save money and improve the economy, with WhiteHouse.gov stating, In keeping with the President’s pledge that reform must fix our health care system without adding to the deficit, the Affordable Care Act reduces the deficit, saving over $200 billion over 10 years and more than $1 trillion in the second decade. The law reduces health care costs … [and] is improving our economic competitiveness[.] . $70.2 billion of the White House’s estimated savings was to come from the Community Living Assistance Services and Supports (CLASS) Act provisions of the Affordable Care Act, a program that was deemed actuarially unsound and never implemented by the Obama Administration. An April 2010 report from the Office of the Actuary for the Centers for Medicare & Medicaid Services describes that additional savings under the Affordable Care Act were to be paid for with Medicare Fee-for-Service and Medicare Advantage cuts and reductions in payments to hospitals, skilled nursing facilities, and home health centers. These cuts have been delayed and may never materialize. Even if implemented, the projected savings may never accrue as the CMS Actuary’s report concludes that such cuts will cause about 15 percent of hospitals and post-acute care facilities like nursing homes to go out of business. $52 billion in deficit reduction savings was projected to come from employer penalties paid to the Government for failure to comply with the employer mandate requirement to provide employees health insurance, a requirement that the Obama Administration has repeatedly delayed and modified, causing penalties and associated savings to not accrue. Initial estimates of savings under the Affordable Care Act projected at least $15.5 billion in savings over the next decade attributable to Medicare cuts through the Independent Payment Advisory Board, which has not yet been appointed and through which no cuts or savings have been realized. On September 9, 2009, President Obama pledged to a joint session of Congress, I will not sign a [health care reform] plan that adds one dime to our deficits—either now or in the future. . The Congressional Budget Office estimated in February 2014 that health insurance subsidies under the Affordable Care Act would cost the Federal Government $47 billion in fiscal year 2015 and $1.197 trillion over fiscal years 2015–2024. The Committees on Finance and Health, Education, Labor, and Pensions of the Senate estimated in September 2014 that the Affordable Care Act will add at least $340 billion to Federal budget deficits. Dr. Gruber stated, The [Affordable Care Act] isn’t designed to save money. . On at least 37 occasions, President Obama or a top official in the executive branch repeated the promise that If you like the [health insurance] plan you have, you can keep it. If you like the doctor you have, you can keep your doctor. . The Associated Press calculated at least 4.7 million Americans had their health insurance cancelled for 2014 and later, when the President issued a last-minute fix to try to prevent these cancellations as required by the Affordable Care Act, the changes came too late for approximately 2.4 million Americans to keep the plans they had and liked. The nonpartisan, fact-checking publication Politifact rated If you like your health care plan, you can keep it. as the Lie of the Year for 2013. Then-Presidential candidate Barack Obama repeatedly promised that, if elected President, his national health care reforms would, cut the cost of a typical family’s premium by up to $2,500 a year. . A November 2013 analysis by the Manhattan Institute calculates that the Affordable Care Act would increase individual marketplace health insurance premiums by 41 percent nationwide between 2013 and 2014. A December 2013 study by Health Pocket, Inc., found that the average individual deductible for a Bronze plan was $5,081 a year, a 42-percent increase from the average plan purchased by an individual in 2013. A February 2013 study by Health Pocket Inc., found that exchange plans under the Affordable Care Act averaged a 34-percent increase in drug-cost sharing compared to copayment and coinsurance rates in the pre-Affordable Care Act market. For the sickest patients needing specialty drugs, the study found copayments increased by 226 percent under a Bronze plan via the Affordable Care Act. A December 2013 study by McKinsey and Company found that insurers offered almost three times as many narrow or ultranarrow network plans in 2014 compared to 2013. Fully 70 percent of Affordable Care Act plans analyzed had narrow or ultranarrow network coverage, meaning coverage for fewer doctors and hospitals than plans sold on the individual market before the law took effect. Details consumers require to make informed decisions about their health care plan coverage under the Affordable Care Act have been withheld or lacked transparency. On September 26, 2013, President Obama said, It will say clearly what each plan covers, what each plan costs. The price will be right there. It will be fully transparent … And so if you’ve ever tried to buy insurance on your own, I promise you this is a lot easier. It’s like booking a hotel or a plane ticket. . HealthCare.gov was established as the website to implement the Federal exchange portion of the Act at a cost of as much as $840 million, including more than $150 million in cost overruns, according to the Government Accountability Office in March 2014. On October 1, 2013, HealthCare.gov launched without adequate security testing, leaving the approximately 250,000 unique users it drew not only vulnerable to identity theft by hackers, but unable to even use the site, as the website was demonstrably unable to handle even 1,100 simultaneous users. For the subsequent months after its launch, HealthCare.gov continued to be plagued by crippling malfunctions, and the dismal performance of the website led only to problems and frustration for millions of Americans. A June 2013 study by the Department of Health and Human Services’ Office of Inspector General revealed that software designed by a principal HealthCare.gov vendor was highly insecure and put the information of more than 6 million Medicare beneficiaries at greater risk from malware, inappropriate access or theft . An April 2014 study by Avalere Health determined that 38 percent of health insurance plans offered on the exchanges under the Affordable Care Act had no information about drug coverage available. Avalere also found that nearly 1 in 4 plans offered insufficient information on which doctors and hospitals are covered. In September 2014, the Administrator of the Centers for Medicare and Medicaid Services reported to Congress that 7.3 million Americans had enrolled in plans through exchanges under the Affordable Care Act, meeting enrollment targets estimated by the Congressional Budget Office and held as a goal by the Obama Administration. Four months later, HHS Secretary Burwell stated that this enrollment data was a mistake that included some 400,000 dental insurance enrollments, the inclusion of which allowed the administration to claim for months that the Affordable Care Act was performing as anticipated which was not in fact a true or accurate representation of the data they had, but would not release to the public. Since implementation of the ACA began, the HHS Secretary has granted over $1 billion in Federal taxpayer dollars to States to help build websites for their own State-based exchanges, yet development and usability issues on short timelines repeatedly caused these same States to seek different options for the 2015 open enrollment period, including opting to revert to enrolling via the Federal HealthCare.gov website. The Affordable Care Act provides opportunities for fraud within subsidy and tax credit issuance. A September 2013 report by the Treasury Inspector General for Tax Administration concluded that, the IRS’s existing fraud detection system may not be capable of identifying ACA refund fraud or schemes prior to the issuance of tax return refunds. . A July 2014 undercover study by the Government Accountability Office determined that fictitious applicants were able to obtain health insurance coverage and taxpayer-funded subsidies on the Federal exchanges using falsified documents in 11 out of 12 cases. The Affordable Care Act has had a negative impact on the American economy. A February 2014 calculation by the Congressional Budget Office found the Affordable Care Act will significantly harm the American economy, reducing the number of hours worked by millions of full-time employees worth of hours. The CBO study noted, The reduction in CBO’s projections of hours worked represents a decline in the number of full-time-equivalent workers of about 2 million in 2017, rising to about 2.5 million in 2024. . History has shown the Special Inspector General model to be successful at saving taxpayer dollars and rooting our waste, fraud, and abuse in large Federal Government programs. Congress and the President have enacted legislation creating Special Inspectors General on three occasions, including to oversee Federal spending and policy implementation for Afghanistan reconstruction (SIGAR), Iraq reconstruction (SIGIR), and the Troubled Asset Relief Program (SIGTARP). SIGAR, SIGIR, and SIGTARP have successfully conducted audits and investigations saving the Federal Government billions in waste, fraud, and abuse, and have helped to identify and prosecute theft and corruption. As of an October 2014 report, SIGAR has produced 57 referrals for suspension and debarment of Federal contractors and employees and produced over $500 million in direct taxpayer savings. According to its final report, SIGIR cost $245 million to operate, but resulted in $645 million in direct savings to the Federal Government, in addition to producing $192 million in seizures and court-ordered penalties, as well as 90 criminal convictions. As of an October 2014 report, SIGTARP has produced 146 convictions and $7.38 billion in fines, penalties, and restitution to the Government and victims. On August 5, 2014, the Associated Press reported that 47 Federal inspectors general sent an unprecedented joint letter to Congress to decry, Obama administration efforts to delay or stall their investigations, citing three examples where Federal agencies have hindered substantive inspector general oversight work by refusing to provide information or documents they are entitled to under the law. The letter from more than half of the Federal Government’s independent inspectors general correctly states, Section 6(a)(1) of the IG Act reflects the clear intent of Congress that an Inspector General is entitled to timely and unimpeded access to all records available to an agency that relate to that Inspector General’s oversight activities. The constricted interpretations of Section 6(a)(1) by these and other agencies conflict with the actual language and Congressional intent. The IG Act is clear: no law restricting access to records applies to Inspectors General unless that law expressly so states, and that unrestricted access extends to all records available to the agency, regardless of location or form. . Congress has a responsibility to exercise prudent stewardship of public dollars, to ensure that laws are well and faithfully executed by the executive branch, to provide for efficacious services for the American people, and to ensure that those who cheat, steal from, or defraud the Federal Government are held to account.
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